ࡱ> <>;y |bjbjEE 4"''O,**mmmmm8f$" m mm JJJmmJJJ-„^X60f,  - m-J  Jf * 3: This document was released ahead of schedule on Thursday 4th October as part of the preparations leading to the decision to announce an early General Election. This shows in a number of ways; firstly the document is repetitive, shows evidence of rushed editing and even a few typographical errors. It is written in large print and is lavishly illustrated with large, coloured photographs intended to make voters feel that all is well in a multicultural NHS. As befits a document intended for electoral consumption from this government there is little detail and in particular no details about sources of funding although I would advise members, given the sustained campaign of hostility to primary care, to assume that the schemes outlines will be paid for from existing budgets. This will include diversion of funds from more favoured areas, such as the West Country, to less favoured areas through the likely abolition of the Minimum Practice Income Guarantee and the imposition of a formula pace Carr-Hill but without any significant rurality factor. It is also likely that performance-related remuneration, such as for the Quality & Outcomes Framework and Access Directed Enhanced Service will be altered even more towards benefiting practices which comply with government demands. The Health Secretary has stated he does not wish to tear up the governments 2004 GMS contract but it does appear that these changes will be negotiated locally, effectively bypassing the GPC. Lord Darzi claims that the governments aims are to make the NHS more fair regarding access to services, more personal with patient choice being embedded beyond which hospital to attend and towards which practice one chooses to register with. The reviewer always thought this was a given fact. The NHS should also be more effective and safer, at risk of stating the obvious. The proposals for primary care are divided into three areas, all of which concern access in some respect. There should be at least 100 new practices including up to 900 GPs, nurses and other healthcare professionals set up in the 25% of PCTs with the poorest provision at present. These should be funded by new resources. They will be innovative and offer extended opening hours. There should be 150 GP-led health centres situated in easily accessible locations offering a range of services to everyone in the vicinity whether or not they are registered. These will be open 0800-2000 seven days a week and maximise the scope for co-location with other services such as diagnostic, therapeutic, pharmacy and social services. These are the so-called polyclinics and should be commissioned on a level playing field from existing GP groups and other providers. PCTs will work with all new and existing practices to develop greater flexibility in opening hours with the aim that at least half of all practices will open each weekend OR one or more [weekday] evenings... Where existing GPs do not start to offer these extended services, PCTs will be able to use the funding we make available for this (NB not new resources) to commission new services from other GPs, GP federations or other providers. Lord Darzi also states that we will ensure that an increasing proportion of NHS payments made to practices will be linked to their success in attracting patients and the results of patient surveys on access including 48 hour access and advance booking. One small encouragement is that he admits that there is confusion about exactly what out of hours care is for and that he proposes to look at this with a view to arriving at a proper definition as part of the next stage of his review. 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